Ignacio Martin-Loeches1, Louise Rose2, Elsa Afonso3, Julie Benbenishty4, Bronagh Blackwood5, Carole Boulanger6, Silvia Calvino-Gunther7, Wendy Chaboyer8, Fiona Coyer9, Mireia Llaurado-Serra10, Frances Lin11, Francesca Rubulotta12, Ged Williams13, Mieke Deschepper14, Guy Francois15, Sonia O Labeau16, Stijn I Blot17. 1. Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland; Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain. 2. Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK. 3. Faculty of Medicine & Health Science, Department of Internal Medicine, Ghent University, Ghent, Belgium; Neonatal Intensive Care Unit, Rosie Maternity, Cambridge University Hospitals NHS Trust, Cambridge, UK. 4. Hadassah Hebrew University Medical Center, Jerusalem, Israel. 5. Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK. 6. Intensive Care Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, UK. 7. Medical Intensive Care Unit, University Hospital of Grenoble-Alpes, Grenoble, France. 8. Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia. 9. School of Nursing, Queensland University of Technology and Intensive Care Services (ICS), Royal Brisbane and Women's Hospital, Herston, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK. 10. Nursing Department, Universitat Internacional de Catalunya, Barcelona, Spain. 11. Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia; School of Nursing, Midwifery, Paramedicine University of the Sunshine Coast, Queensland, Australia. 12. Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Critical Care, McGill University Health Centre and Department of Critical Care, Faculty of Medicine, McGill University, Montreal, Canada. 13. South Metropolitan Health Service, Perth, and School of Nursing and Midwifery, Griffith University, Australia. 14. Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium. 15. Division of Scientific Affairs‑Research, European Society of Intensive Care Medicine, Brussels, Belgium. 16. Nursing Department, Faculty of Education, Health and Social Work, HOGENT University of Applied Sciences and Arts, Ghent, Belgium. 17. Department of Internal Medicine and Pediatrics, Faculty of Medicine, Burns Trauma and Critical Care Research Centre, Ghent University, The University of Queensland, Campus UZ Gent, Corneel Heymanslaan 10, Brisbane 9000, Australia. Electronic address: stijn.blot@UGent.be.
Abstract
BACKGROUND: Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. OBJECTIVE: To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. STUDY DESIGN AND METHODS: This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). RESULTS: Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). CONCLUSION AND IMPLICATIONS: Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
BACKGROUND: Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. OBJECTIVE: To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. STUDY DESIGN AND METHODS: This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). RESULTS: Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). CONCLUSION AND IMPLICATIONS: Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.